Arterial Diseases
Aortic Dissection
Medical Emergency
In case of a medical emergency, call 112 (the European emergency number) or go to the nearest emergency department.
Written byTriantafyllos Giannakopoulos MD, PhD, FEBVS, FACSMedically reviewed: 27 July 2026
Aortic dissection is a serious condition where the inner wall of the aorta tears. This can lead to dangerous complications and requires immediate medical care. Timely diagnosis is vital.
Mechanism
How does aortic dissection occur?
The aortic wall consists of 3 thin layers that are connected to each other, forming the tubular structure of the vessel. If the inner layer (that comes into contact with blood) tears, blood enters between the layers, separating them from the middle layer and occupying space from the vessel lumen where blood circulates.
This is called dissection and can extend to varying extents. The point of dissection can lead to aneurysm due to loss of cohesion of the aortic wall.
Rapid Progression
Extends quickly along the aorta
Peripherally
Also into the branches of the aorta
Reduced Blood Flow
Decreased blood supply to organs
Clinical Picture
Symptoms of Aortic Dissection
The predominant symptom of aortic dissection is sudden tearing back pain in a patient already suffering from arterial hypertension, while it is not uncommon for the disease to first appear in relatively young patients who have undiagnosed arterial hypertension.
Emergency Condition
Aortic dissection requires immediate medical evaluation and treatment. Do not ignore sudden and severe pain in the back or chest.
Sudden tearing back pain
Classification
Types of Aortic Dissection
There are two main types of aortic dissection: type A and type B. Type A dissection affects the ascending aorta, which is the portion of the aorta that emerges from the heart. Type B dissection affects the descending aorta, which is the portion of the aorta that descends from the heart.
Type A
Ascending Aorta
Type A dissection affects the ascending aorta, the portion emerging from the heart.
Note: Usually requires emergency surgery
Type B
Descending Aorta
Type B dissection affects the descending aorta, the portion descending from the heart.
Note: Can be managed with medication or endovascular techniques
The three types of aortic dissection
Therapeutic Approach
Simple therapeutic approach for aortic dissection
Therapeutic algorithm for aortic dissection
Diagnosis
Diagnosis of aortic dissection is made with CT angiography (CTA) of the thoracic and abdominal aorta, to locate the entry and exit points of the dissection as well as branch involvement (Ischemia-Thrombosis).
Modern Management
Timely and accurate diagnosis combined with the availability of newer endovascular techniques and stent grafts allows us to quickly limit ischemic complications, prevent aneurysmal degeneration, and also manage dissecting aneurysm when it occurs.
Limiting Ischemic Complications
Rapid intervention to protect organs
Prevention of Aneurysmal Degeneration
Preventing further complications
Endovascular Techniques
Modern stent grafts and minimally invasive methods
CT Angiography (CTA)
Restoration Methods
Endovascular Repair - EVAR
Minimally invasive with a stent graft (covered stent) from the femoral arteries.
Endovascular Repair - EVAR
Classic Open Surgery
The aorta is replaced with a synthetic graft.
Classic Open Surgery
References
- Wanhainen A, et al. ESVS 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases. Eur J Vasc Endovasc Surg 71(2):172–270 (2026) — doi.org/10.1016/j.ejvs.2025.12.050
- Trimarchi S, et al. ESVS 2025 Clinical Practice Consensus Statement on Ascending Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 70(1):10–23 (2025) — doi.org/10.1016/j.ejvs.2025.05.023
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In case of a medical emergency, call 112 (the European emergency number) or go to the nearest emergency department.